The health care sector is a completely unique environment. Hospitals are open 24/7/365, and people are engaged in this environment … walking on the floors, sitting in the furniture, touching walls, cleaning the wards … every minute of every day. It’s a highly used, highly abused environment. Designing for that is a real challenge, but once you’re in that world you learn more; you become more efficient, and you’re more in demand,” notes Marie Lukaszeski, AAHID, IIDA.

Lukaszeski gravitated toward health care when she was selling furniture 15 years ago because she found the field, and the clients, more interesting. “The facilities guys, on one side, want everything to be bulletproof and would prefer it if everything was white and beige. The executive team wants to invite managed care into their facility, so they want it to be aesthetically-pleasing and clean. The maintenance people want to be sure it’s easy to clean. And the public, the consumer, wants to choose between facilities.

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“So you’ve got all of these different facets that you design around, and ultimately, you need to have a product that’s safe for the staff to use, and for the public to interact with—and aesthetically-pleasing and clean for patients to heal in.”

A few years ago, Lukaszeski received additional insight into health care design via personal experience. A minor issue during the birth of her second child sent the infant to the neonatal intensive care unit (NICU) at Lafayette General Medical Center (LGMC), in Lafayette, LA. Ironically, she had just started working with LGMC’s neonatologist on redesigning the NICU two weeks earlier.

“I never dreamed that he’d be caring for my child,” she says. “He had trouble regulating his breathing, so the doctors recommended he go to the NICU to stabilize and get stronger. I didn’t get to see him for the first 20 hours after he was born. Finally, at three in the morning I couldn’t take it anymore; I told the nurse I had to see my baby.

“When they wheeled me into the NICU, I was confronted with all these tubes and buttons and machines, and all the babies were lined up against the wall. It’s a frightening experience as a parent—[it’s] even worse if your baby isn’t as healthy as I knew mine was.”

That experience drove Lukaszeski to visit several different NICUs. “I needed to understand how important the healing environment is for babies, and for the families helping these babies to grow. My experience with how people interact with this built environment was very fresh in my mind.”

Preformed Wall Base Corners: Designed for Easier, More Attractive Installations

Some manufacturers offer preformed wall base components for inside and outside corners. These products increase productivity and ease of installation compared to traditional on-site flash coving, which is often time consuming to install and can be unsightly—especially on corners.

Preformed corners are designed to be heat welded to vinyl and rubber flooring products along with heat-weldable resilient solid vinyl tile and vinyl sheet flooring. This system provides an almost seamless application, allowing ease of cleaning while aiding in the prevention of bacterial growth. The flexibility of these systems helps conceal floor and wall irregularities while providing a tough finish to resist scuffing and gouging—and the color is homogeneous throughout the entire thickness of the wall base.

Typical characteristics of premium preformed corners:

May contribute to LEED® Credits: MR 4, MR 5
and MR 6

6” height for better protection of wall surfaces (can be trimmed and capped when shorter height is required)

Adhesives contain an antimicrobial agent for added
protection against mold and bacteria

Typical benefits:

The integrity of the corners is superior to flash coving,
and the consistency of the cove is easier to achieve versus self-coving.

Cove stick and cove caps are not required. Cove
stick is built into the back of the base for faster installation. The top of the base is tapered to the wall to ensure a smooth, seamless application at the top to the wall surface.

Installation recommendations:

Maintain the installation area, wall base, and
adhesive(s) between 65º F (19º C) and 85º F (30º C) for at least 48 hours before installation, during installation and thereafter.

Perform a bond test at least 72 hours prior to the
scheduled installation to ensure the surface is suitable. There should be extreme difficulty in removing the wall base from the wall and floor surface.

Preformed corners should be installed after all other
finishing operations, including painting, to prevent damage.

Seams must be heat welded for seamless installation; some
products also allow cold welding with proper caulks.

Install corners first to ensure proper fit and alignment.

Chemical welding cannot be used on the vertical
seams due to liquidity of the chemical weld.

Avoid installation:

On any surface that will be exposed to moisture or
extreme temperature changes.

If installing over a vinyl wall covering, cut and remove the wall covering ¼” (6.35 mm) below the top and expose the substrate completely.

Her design for LGMC included concealing apparatuses where possible, increasing privacy for families, and getting the omnipresent audible monitor alerts and harsh lighting under control. A pinwheel layout model allows for clusters of three baby areas with half-height walls; decentralized nursing stations minimize staff footsteps.

“Flooring is a big issue for NICUs,” says Lukaszeski. “It’s a challenge to get inside a NICU for a terminal clean. A floor that requires waxing multiplies this challenge, and there’s an odor associated with stripping and waxing floors that you just can’t have in a NICU, which means all the babies need to be moved somewhere else during waxing and drying, for three or four days at least four times a year. Hospital staffs often complain that the chemicals involved give them headaches.

“We chose rubber floors for many reasons. They are naturally antimicrobial; they provide cushion underfoot for the nursing staff; [they are] durable enough to withstand the constant cart traffic; and, of course, they don’t need to be waxed. They are easily maintained daily with an auto scrubber, and the more you do that a rich patina develops on the surface of the floor, making it look shiny and clean. The enhanced sheen on the surface of the floor looks like a highly polished wax, but there are never any odors or chemicals related to stripping. Rubber’s ease of maintenance was the deciding factor.”

The 14-bed NICU at LGMC was being replaced by a 25-bed facility. Initial plans called for dividing it in half, so when the census was low enough you could move babies to one side for a terminal clean of the other. In reality, the census never dropped enough to allow this to happen. With the new layout and rubber floors, no part of the unit needs to be shut down for cleaning.

The rubber floor also plays a role in reducing the noise in an area like a NICU—absorbing ambient noise and reducing the sounds of rolling carts and footsteps, creating a more peaceful environment in which to visit and heal.

“Color also plays a role in healing,” says Lukaszeski. “We worked with a supplier that had colors that are playful and fun. We used a lot of saturated color … greens and blues … which add a nice aesthetic to that area. You don’t feel like you’re in a hospital ward, but in a baby’s room.”

LONG-TERM BENEFITSThe NICU project was budgeted at $2.9 million, and the first round of pricing came in at $4 million.

“We had a million dollars to cut, and the contractor was coming back with line items of $30,000 or $40,000. The rubber flooring came up—we would save $30,000 by switching to VCT. I had to stand up and explain to the CEO and COO of the hospital why, not only from an operational standpoint, but from a health and safety standpoint, we needed to leave rubber in the job.”

Architect Suzanne Barnes compares the value and costs of different flooring options for health care installations in her study, “How to Make Business Decisions for Facility Flooring.” The study took several years to complete and it concluded that several floors met the criteria for a high-use installation, including rubber flooring, no-finish vinyls and other low-maintenance floors. These flooring options could also easily be the most aesthetically-pleasing choice if the color and pattern are chosen wisely.

“Rubber flooring was a prime candidate because we knew it lasts longer, looks better, is much more comfortable to stand and work on, safer to walk on, safer to fall on, and it requires much less effort and upkeep,” says Barnes. “It’s more expensive initially, but you definitely get what you pay for; in the long run, it pays for itself.”

Because of the nature of hospitals, the study focused mostly on hard floors. They have the best life-cycle cost results; don’t “ugly out” after five years; don’t retain stains and smells; appear to be more sterile; and don’t take as long to dry. Carpeting was included in the study for comparison’s sake because it is such a familiar option.

In assessing relative costs, Barnes’ research pitted the life-cycle costs of rubber flooring against VCT, linoleum, carpet, sheet vinyl, and simulated wood—all from several manufacturers. Four methodologies were used:

Initial cost

Replacement cost

Maintenance/labor costs

Total life-cycle cost replacement

The Basics of Rubber Flooring in Commercial Design

Most architects like really repetitive things, so everything looks very geometric,” says Florida architect Suzanne Barnes. “But spills and stains are not geometric, they’re organic. So are traffic patterns. In a hospital, of course, you don’t want to hide the bacteria, but you do want to hide stains like a coffee spill or chemo fluids. Complex organic patterns do a great job hiding these, as well as scuff marks. As a result of the study we stopped specifying solid-color floors.”

Some rubber floors have the properties of a no-wax tile. Waxes are “built into” the tile and migrate to the surface when they are properly given routine maintenance. This provides a pleasing surface luster and helps keep harmful finishing and waxing chemicals out of the environment.

Rubber flooring manufacturers have expanded their product lines over the years, and designers can now choose from a wide range of texture and color
combinations. For clean rooms and areas with the strictest hygiene requirements, rubber sheet flooring allows designers to create seamless installations. Further, most adhesives used to install rubber floors contain an antimicrobial agent for added protection against mold and bacteria, and rubber tile has a natural resistance to bacteria and fungi when tested in accordance with ASTM G 21. Some rubber tiles also meet chemical resistance specifications, in accordance with ASTM F 925.

A further benefit to specifying rubber floors is, of course, the environmental advantages of rubber as a material and how it contributes to the LEED certification process. Where other flooring options present inherent environmental challenges, rubber as a material has helped buildings achieve LEED Platinum status.

Rubber flooring can impact a LEED project from a variety of angles. Many rubber tiles are constructed of as much as 90 percent post-consumer waste when manufactured using post-consumer recycled tires. Also, rubber tiles are partially compounded using natural rubber (a renewable resource from the rubber tree). And no-wax rubber floors are environmentally friendly because harmful refinishing chemicals are not put back into the environment and they require less water usage to maintain.

ENVIRONMENTAL IMPACT
Indoor air quality is also positively impacted by the specification of rubber flooring. Rubber tile contains no PVCs and will not emit vinyl chloride, plasticizers, asbestos, or CFCs. Air quality is a major concern and may be affected by emissions from the flooring material itself, as well as from the adhesives used to install the floor and surface coatings and maintenance materials like wax and strippers. The low-maintenance nature of rubber flooring helps specifiers minimize these environmental pitfalls.

Several rubber flooring manufacturers have conducted independent indoor air quality tests and have received certification from nonprofit organizations such as the Collaborative for High Performance Schools (CHPS), which follows the same protocol as other programs such as GREENGUARD, FloorScore and Green Label Plus. A list of materials for school construction that are environmentally sound has been prepared by CHPS and is available at www.chps.net.

Rubber floors can also be engineered with antimicrobial properties as well as resistance to food service hazards like grease and oil. The grease- and oil-resistant features can be achieved by adding a topical coat or by incorporating the mixture into the formula of the rubber tile. Topical coats can wear off, but the formulas that are incorporated into the rubber assure that the tile continues to perform as it was intended.

“Rubber is my favorite type of floor for commercial installations,” says Barnes. “Every day I see other flooring materials that should never have been specified for those applications. I’ve seen terrazzo in grocery store produce sections. Terrazzo is very slippery when it gets wet—which happens often in a produce section—and very unforgiving if you should fall. Rubber would be a much better choice. Airports are also a great candidate because of the unbelievably heavy traffic they get. Even corporate offices would benefit from rubber floors, for noise control, comfort, design, and durability. The Europeans seem to be ahead of the U.S. in this respect.

“If you’re specifying floors for long-term durability, or if safety, low maintenance and environmental friendliness are your goals, rubber should be at the top of your list.”

To drive the comparisons home, Barnes expressed the life-cycle costs as a multiple of the initial cost of installation.

As you can see, VCT had the lowest initial cost at $1.20-1.50 per square foot, but its maintenance costs over 15 years were the second highest overall, and 17 times the initial installed cost. The only flooring that was more costly to maintain than VCT was sheet vinyl. Carpeting had the second highest life-cycle cost multiple at nine times the original investment, followed by sheet vinyl at eight times. The carpeting had to be replaced three times over the 15-year period.

In the end, the “cheapest” floor—VCT—was a very expensive choice; and a more expensive floor— rubber—was actually the cheapest at a little over half the cost of the next closest option. Even at five years, Barnes noted in the study, the payback for some of the more expensive floors had disqualified the cheaper floors.

“Our original methodology had been: design, budget, install, and then suffer—suffer the consequences,” says Barnes. “We thought we were saving $3 a square foot by using VCT everywhere, but our methodology was all wrong. We studied these floors in patient rooms, cafeterias, lobbies, corridors, and nurses’ stations. After the study, we only considered carpeting for lobby areas, corridors (for its acoustic properties), nurses’ stations (for comfort), and cafeterias (for aesthetic reasons). This of course meant we would be paying a higher price for better quality carpet.

“Theoretically, in a large hospital over 15 years’ time, we could save millions of dollars by installing floors that do not require finishing. In the case of VCT, initial pennies saved could mean millions lost. Rubber seems to be the best product overall. It doesn’t move over years, decay or wear like most other products.”

ON TO LARGER THINGSWith the NICU project completed, LGMC hired Lukaszeski to select a truly no-wax floor for a $70 million renovation of its 10-story hospital, including a pediatric emergency room area.

“When I started doing research, the first thing that came to mind is, ‘We’ve already got a no-wax floor in the hospital, why would we look for anything else?’ We’re using a lot of natural color, beige, gray, and charcoal. We have the benefit that every patient room in the hospital has natural light coming in, which is wonderful. We’re using a lot of artwork; privacy curtains add a little bit of texture, and the furniture has complementary patterns and colors. Our rubber flooring supplier worked with us to create some custom colors for this project, which I believe they’ve since added to their standard line.

“Everywhere we’re renovating, we’re using rubber flooring—corridors, patient rooms, patient restrooms, behind nurses’ stations, in closets, in linen closets, and in the pediatric emergency treatment area. It’s tough, it’s slip resistant, and it’s perfect for our design goals,” notes Lukaszeski. “We used a combination of sheet goods and tiles. For the NICU and patient restrooms, we used rubber sheet product. The pediatric ER was a combination of sheet goods and tile, and the patient rooms and corridors are rubber tiles.”

Sheet products require rubber welds to create a monolithic floor, keeping fluids and contamination from getting beneath the rubber floor and coves; in tile installation, the butt joints form a tight enough seal without further treatment needed.

As the project moves forward, Lukaszeski plans to explore the use of preformed wall base corners to speed installation and enhance appearance. (See the sidebar for more on preformed wall base corners.)

“Where we wanted graphics and designs—like in the NICU, the river and lily pads in the pediatric ER, the curve in the patient rooms, or the LGMC logo design in the elevator lobby—we had the rubber tiles cut by water jet before installation. Our contractor seems to be able to cut whatever we can imagine.”

Lukaszeski says by choosing rubber flooring for the 200,000-square-foot project, the hospital will save—conservatively—$150,000 on maintenance in the first year alone.

Advantages

While rubber floors are more expensive than other flooring options, they offer a unique
combination of advantages:

The lowest lifetime maintenance costs of major flooring options

Resilient surface (for safety, in the event of a fall), and comfort—reduced leg and
back fatigue